The Leadership of Service

Using experiences at Memorial University of Newfoundland as a basis, this essay suggests that leadership should be an expectation of professional academics in all the categories of their work, namely teaching, research and service. The desirability of developing the leadership of service in particular is advanced as an appropriate expectation for faculty members career progress. Developing a general leadership ethos is both philosophically appropriate and practically advantageous in collegial organisations.     

Kicking coordination captures differences between full-term and premature infants with white matter disorder

This study explores the relation of white matter disorder (WMD) to intralimb coordination patterns in premature infants with very low birth weight (VLBW). We specifically measured the temporal-spatial characteristics of intralimb coordination patterns of the legs. Three groups of infants were compared at one month corrected age (CA): 10 premature infants born VLBW and WMD (PTWMD), 10 premature infants born VLBW without WMD (PT) and 10 full term infants (FT). Using kinematic variables, we discriminate among VLBW infants with WMD from the two comparison groups. Infants born with WMD maintain patterns of tight coupling among leg joints (all flexion or all extension) while PT and FT term infants have begun to decouple leg joints by this age (combinations of flexion with extension). The coupling pattern is captured through joint correlations, discrete relative phase, and phase plane portraits. The PTWMD infants also demonstrate aberrant patterns of coordination evident through both temporal and spatial characteristics of the kicks. This is the first evidence that movement disorder associated with brain lesions can be identified and quantified with kinematic variables as early as one month of age.     

“What Button Do I Press?” the Consequences of Conducting a Service Learning Project with Senior Citizens

In an effort to build interest in the two-year old service learning center and to fulfill its mission to integrate academic life with service in thoughtful and relevant ways, a competition was held to award developmental grants to faculty to create innovative courses incorporating service learning. The winning proposal from the business school used a business ethics course as the vehicle for formally introducing service into the business curriculum. This paper will tell the story of the intended and unintended consequences of building collaboration on several levels: between generations, between college and community, between faculty and college resources, between student teams, and between theory and practice.     

Ecological Factors Impacting Provider Attitudes Towards Human Service Delivery Reform

Although reform efforts are substantially altering the structural operations and guiding ideological framework of the human service delivery system, little empirical work has been done to systematically examine these transformations. This study examines providers' attitudes regarding two reform elements that are being widely implemented: an increased emphasis on inter-agency collaboration and a shift from a medical model service delivery philosophy, that focuses on client deficits, to one that emphasizes consumer strengths. Through survey data collected from 186 providers from 32 human service agencies in one county, the relationship between providers' perceptions of contextual support for human service delivery reform and providers' attitudes towards these initiatives is explored. The findings from this study support the importance of attending to the ecology in which we initiate system reform efforts. For both reform elements, working within contexts that are perceived as providing ideological and functional support for change was associated with positive provider attitudes towards those changes. Staffs' perceptions of the external environment played the most critical role in shaping staff attitudes. Interestingly, unique aspects of providers' work environments were related to positive attitudes towards the two different reforms. The implications of these findings for the success of human service delivery reform are discussed.     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

Developing community alternatives to group home placement for SED special education students in the Ventura County System of Care

Interagency planning and resource development were used to improve available services for severely emotionally disturbed special education students who were in or at-risk of being placed in residential care. Augmented local school-based and regional day treatment services were financed by a Ventura County Social Services Agency trust fund and delivered cooperatively by the County Mental Health Agency and local education agencies. Revenues generated by the new service positions were planned to restore the trust fund. Outcomes following service implementation included: (a) an average reduction of 3.5 youths in the expected number of youths in group home placement per month; (b) a total reduction of $290,011 in the expected annual cost of placement; and (c) generation of $281,238 in Medi-Cal revenue by the school-based and day treatment components of the system of care. The implications of these outcomes are discussed in terms of existing trends in numbers of identified seriously emotionally disturbed students and their service needs and the processes that were involved in planning and implementing the service augmentation.     

Predictors of Placement Outcomes in Treatment Foster Care: Implications for Foster Parent Selection and Service Delivery

Treatment foster care (TFC) is a normalizing environment in which to treat those children whose particular needs are not addressed in traditional foster care and for whom an institutional setting is a restrictive and unnecessary alternative. However, when the foster care placements of these emotionally and behaviorally disturbed children fail, as they often do, the children are shifted from one home to another without the opportunity to experience permanence or emotional attachment, resulting in poor adjustment to foster care. Placement stability, which depends in part upon effective matching of foster children with potential foster families, is critical for achieving positive outcomes in TFC. Yet, there is a dearth of information to guide placement agencies in making decisions about matching foster children with families. Moreover, once a successful match has been made, it is equally vital that service delivery be of high quality so that permanence is maintained. We review research on the predictors of positive outcomes in foster care, focusing on studies involving emotionally or behaviorally disturbed children, and provide recommendations for selecting foster parents and for ensuring high quality foster care services and placement stability.     

Possession and Medicine in South Central India

Possession is a powerful and surprisingly prevalent belief system in many parts of the developing world. In India it is common for many reasons—isolation, illiteracy, polyglotism, lack of an adequate medical infrastructure, a need for hope. Possession, and the practice of exorcism, is more than just an explanatory system based on superstition and folk lore. It is also an important social structure and force that allows the integration of the sick into the community of the well, and facilitates a first albeit tentative step from the local community to the medical community. In many parts of India, health care delivery as well as social organization is through the practice of possession. Thus, the role and power of possession needs to be appreciated if one seeks to affect health care delivery in India, and further possession should be appreciated if one seeks to better understand how some of its forces might in fact be curative.     

Effect of Stroke on Joint Control during Reach-to-Grasp: A Preliminary Study

Abstract

We investigated changes in control of inter-segmental dynamics underlying upper extremity dyscoordination caused by stroke. Individuals with stroke and healthy individuals performed a natural reach-to-grasp movement. Kinetic analysis revealed that both groups rotated the shoulder by muscle torque and used interaction torque to rotate the elbow. However, individuals with stroke used interaction torque less than healthy individuals, actively suppressing a substantial portion of it. This resulted in inefficient use of active control and dyscoordination of the upper extremity. The degree of interaction torque suppression and inefficiency of active control at the elbow positively correlated with stroke severity. The increased interaction torque suppression can be a strategy used by individuals with stroke to compensate for deficient feedforward control of this torque.     

新型农村合作医疗的受益公平性研究

2003年,我国开展了新型农村合作医疗制度(以下简称“新农合”)试点工作。利用新农合试点县卫生服务调查资料,从卫生服务需要量、利用率、医疗费用以及从新农合得到的费用补偿等方面分析不同收入水平的参合农民的受益情况。结果显示,贫困农民卫生服务需要量大,卫生服务需求的未满足程度较高,从合作医疗中受益相对较少。认为不同经济状况的参合农民在卫生服务利用中存在不公平现象。